CARDIAC PROTECTION THERAPY CAN PREVENT THE ELEVATION OF CENTRAL BLOOD PRESSURE IN ADULT PATIENTS WITH CONGENITAL HEART DISEASE

Abstract

There is no evidence of beneficial effect of cardiac protection (CP) therapy for heart failure, that is medication of renin-angiotensin system antagonists and beta blockers, in patients with congenital heart disease (CHD). However, these drugs have blood pressure (BP) lowering effect and may prevent future hypertension in CHD patients, who are high risk for hypertension. Therefore, we examine the BP lowering effect of CP in adults with CHD.We enrolled 131 consecutive subjects aged > 20 years who visited the Department of Adult Congenital Heart Disease, Chiba Cardiovascular Center. The exclusion criteria were as follows: (1) a history of atrial fibrillation or frequent supra or ventricular premature beats, (2) history of cardiac operation in the past 6 months, (3) medication for hypertension, and (4) NYHA II-IV. We divided the remaining 60 patients into cardiac protection (+) and (-) and compared their brachial and central systolic BP (SBP). We defined a patient whose brachial SBP was higher than 1SD of age and sex matched control (Japanese general population) as high SBP. Moreover, we defined a patient whose central SBP was higher than 1SD of control as high central SBP.Fifteen patients were medicated CP drugs (carvedilol 7, bisoprolol 1, enalapril 11, candesartan 2) (CP+). The mean age was 34.1 ± 13.2 years in CP- and 30.3 ± 11.4 in CP+. The brachial systolic/diastolic BP was 124.4 ± 19.7/74.6 ± 14.0 mmHg in CP- 116.7 ± 12.5/66.2 ± 12.1 mmHg in CP+. There were 14 high SBP patients in CP- and one patient in CP+ (p = 0.0535). The central SBP was 126.8 ± 21.0 mmHg in CP- and 113.2 ± 16.0 mmHg in CP+. There were 16 high central CBP patients in CP- and one patient in CP+ (p = 0.0043).The number of high central SBP in patients with CP+ was smaller than CP-. It may be obvious because the drugs used for CP have BP lowering effect. It is well known that hypertension is popular in patients with CHD. CP drugs for heart failure may prevent future cardiovascular disease in patients with CHD.